2015-06-08苏州办公室装修不完全川崎病超声的冠状动脉逐渐变细征以及周围回声强度的诊断意义如何?-永军医学笔记及英文朗读

不完全川崎病超声的冠状动脉逐渐变细征以及周围回声强度的诊断意义如何?-永军医学笔记及英文朗读狄光远
经胸超声心动图是诊断川崎病冠状动脉疾病首选和主要的检查手段, 所有诊断川崎病患儿均需在急性期、 恢复期和随访中定期进行经胸超声心动图检查。除了测量冠状动脉内径外,还要观察是否冠状动脉缺乏正常的逐渐变细(tapering)特征新汶吧 , 以及冠状动脉周围回声或“亮度”异常。

黄色箭头分别为右冠状动脉、左侧冠状动脉缺乏正常的逐渐变细(tapering)征
冠状动脉扩张标准:(1)冠状动脉直径5 岁以下>3 mm地球试炼场,5 岁及5岁以上>4 mm;(2)内径≥邻近段的1.5倍。由于不同年龄体重冠状动脉直径差异较大,美国及世界各地越来越多学者主张用体表面积校正的冠状动脉值(z值)诊断冠状动脉扩张更合适, z值≥2.5为CAA; z值在2.0~<2.5,并存在冠状动脉周围回声增强或冠状动脉缺乏正常的逐渐变细为冠状动脉扩张。(摘自川崎病血管合并症的处理与随访.中国实用儿科杂志 2017,32(8):579-584)
由此可见,冠状动脉逐渐变细征以及周围回声强度是临床是有一定应用价值的指标。但是何禹萱,已经有文献对冠状动脉逐渐变细征以及周围回声强度诊断意义提出质疑郓城人才网 。
我下面进行文献介绍。
不完全川崎病:冠状动脉逐渐变细征以及周围回声强度的诊断意义探析
Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease
在2017年,美国心脏病协会公布了川崎疾病诊断的修订指南。在缺乏令人信服的数据支持或驳斥缺乏冠状动脉逐渐变细征以及周围回声强度的效用的情况下,专家小组一致将冠状动脉逐渐变细征以及周围回声强度排除在讨论范围之外。研究者假设冠状动脉逐渐变细征以及周围回声强度是不可靠的主观发现,对川崎病非特异性。冠状动脉逐渐变细征以及周围回声强度增加可以在非川崎病的发热性疾病和正常对照组中看到。苏州办公室装修
In 2017, the AHA published revised guidelines for the diagnosis of Kawasaki disease (KD). In the absence of compelling data supporting or refuting the utility of lack of tapering (LT) and perivascular brightness (PB), expert panel consensus removed LT and PB from consideration. We hypothesize that LT and PB are unreliable, subjective findings, non-specific to KD, which can be seen in systemic febrile illnesses without KD and in normal controls.
研究者进行了2008至2016年间的单中心回顾性研究。6名儿科心脏病专家盲法判读了0-10岁患者的冠状动脉超声心动图跑牛网 。受试者分为:(1)健康:无热伴良性杂音恶魔恋爱啦,(2)川崎病:IVIG治疗,4-5项临床表现标准,多田薰 (3)不完全川崎病:IVIG,1-3项临床标准,(4)发热:≥3天发热,无IVIG,川崎病可疑。记录冠状动脉逐渐变细征以及周围回声强度的存在或不存在。使用等级内相关系数、Fleiss's Kappa和Cohen's Kappa系数分析等级间和等级内的可靠性。
We performed a single-center retrospective study from 1/2008 to 12/2016. De-identified coronary artery (CA) echocardiographic clips from patients 0–10 years old were interpreted blindly by six pediatric cardiologists. Subjects were grouped as follows: (1) healthy: afebrile with benign murmur50路熟女, (2) KD: IVIG treatment, 4–5 clinical criteria at presentation, (3) incomplete KD (iKD): IVIG, 1–3 clinical criteria, (4) Febrile: ≥3 days of fever, no IVIGenakei, KD not suspected. The presence or absence of LT and PB was recorded. Inter-rater and intra-rater reliabilities were analyzed using intra-class correlation coefficient, Fleiss’ Kappa and Cohen’s Kappa coefficients.
研究者从健康(27例)、川崎病(30例)、不完全川崎病(32例)和发热(28例)受试者中判读了117个超声心动图。分析表明冠状动脉测量Z值中度一致。对于对照组病例,大部分受试的医师也给出缺乏冠状动脉逐渐变细征以及周围回声强度增强的判断。周围回声强度增强在不同医师判读的一致性尚可(信度系数0.36)和周围回声强度的医师间一致性差(可靠性系数0.13)。两个参数的组间信度不一致。
We interpreted 117 echocardiograms from healthy (27), KD (30)任灿灿, iKD (32), and febrile (28) subjects. Analysis showed moderate agreement in CA z score measurements. LT and PB were observed by most readers in control groups. LT exhibited fair inter-reader agreement (reliability coefficient 0.36) and PB slight inter-reader agreement (reliability coefficient 0.13). Intra-rater reliability was inconsistent for both parameters.
冠状动脉逐渐变细征以及周围回声强度是主观指标,重现性差,可以在没有川崎病的发热患者和健康儿童中看到fw150r 。
LT and PB are subjective, poorly reproducible features that can be seen in febrile patients without KD and in healthy children..
【延伸阅读】
Rabinowitz杨思慧, E.J., Rubin新闻深喉咙 , L.G., Desai分割人生 , K. et al. Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease.Pediatr Cardiol (2018).
【阅读花絮】
以往见到的类似文献,比较的是观察者间组内相关系数( intraclass correlation coefficient翌景嘉园 ,ICC )。